Stream: financial
Topic: Appeals and Grievances
Linda (Dec 10 2019 at 19:02):
Appeals and Grievances - is anyone using FHIR Resources to represent this work? If so, what are you using in the way of Resources.
Lloyd McKenzie (Dec 10 2019 at 19:14):
@Paul Knapp
Linda (Dec 10 2019 at 19:30):
If useful - one example would be to support this Medicare process, https://www.cms.gov/Medicare/Appeals-and-Grievances/MMCAG/Downloads/Parts-C-and-D-Enrollee-Grievances-Organization-Coverage-Determinations-and-Appeals-Guidance.pdf
Linda (Dec 17 2019 at 16:32):
So I hear Communication Request might be used for Appeals. Mary Kay McDaniel, Financial Management co-chair, will be setting up a meeting to discuss further. I wanted to post here because from what I see both Communication Request and Service Request seem to be more clinical than administrative. Are we off on the right foot or not?
Lloyd McKenzie (Dec 17 2019 at 16:48):
CommunicationRequest is not appropriate for this. We need to remember that everything in FHIR is communication. CommunicationRequest is about authorizing the sharing of data from one individual to another.
Lloyd McKenzie (Dec 17 2019 at 16:48):
It's not a vehicle for "I need to say X, so I'll just wrap it in a CommunicationRequest because I'm communicating"
Linda (Dec 17 2019 at 18:01):
Who can we invite to this group that could help us conceptually with what we should use or if we need a new resource like FinancialCommunicationRequest - Iknow too long of a name :)
Lloyd McKenzie (Dec 17 2019 at 18:03):
I'm not sure you need a new resource. This seems like "please initiate process XYZ" situation which would generally be handled using Task. (It's the general purpose 'please do' resource.)
Linda (Dec 17 2019 at 20:31):
ThanQ Lloyd!!
Last updated: Apr 12 2022 at 19:14 UTC
